=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730530304
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LILEEN M NEVERS-EMILIMOR LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2016
-----------------------------------------------------
Last Update Date | 06/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6270 SW 8TH CT
-----------------------------------------------------
City | NORTH LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33068-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-993-5429
-----------------------------------------------------
Fax | 954-532-4434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6270 SW 8TH CT
-----------------------------------------------------
City | NORTH LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33068-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-993-5429
-----------------------------------------------------
Fax | 954-532-4434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH13884
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------